Differences in HIV care between patients with and without severe mental illness

Area of Science:

• Public Health
• Mental Health Services Research
• Infectious Disease Epidemiology

Background:

• Individuals with severe mental illness (SMI) often experience complex health needs.
• Co-occurring HIV infection and SMI present unique challenges in healthcare delivery.
• Understanding disparities in HIV care for this population is crucial for improving outcomes.

Purpose of the Study:

• To compare the quality and accessibility of HIV care for patients with and without SMI.
• To identify specific areas of difficulty in HIV care experienced by patients with SMI.

Main Methods:

• A comparative study using interviews and chart reviews of 295 HIV patients with SMI and 1,294 HIV patients without SMI.
• Data collected from public mental health agencies in Los Angeles and New York City.
• Key measures included access to care, patient satisfaction, hospital care quality, health status, and disability days.

Main Results:

• HIV patients with SMI reported more difficulty obtaining care, lower provider recommendation rates, and poorer hospital care experiences.
• Patients with SMI also experienced worse functional health status and more disability days.
• Adjustments for sociodemographic factors, drug use, and CD4 count reduced some disparities, particularly in Los Angeles.

Conclusions:

• Patients with SMI encounter significant obstacles in receiving adequate HIV care compared to those without SMI.
• Intensified case management for patients with SMI showed potential in mitigating some care disparities.
• Further research is needed to address systemic barriers and optimize HIV care for individuals with co-occurring SMI.